If getting pregnant has been a challenge for you and your partner,
you're not alone. Ten percent to 15 percent of couples in the United
States are infertile. Infertility is defined as not being able to
get pregnant despite having frequent, unprotected sex for at least a
year.

If you've been trying to conceive for more than a year, there's a
chance that something may be interfering with your efforts to have a
child. Infertility may be due to a single cause in either you or
your partner, or a combination of factors that may prevent a
pregnancy from occurring or continuing.

Most experts define infertility
as not being able to get pregnant after at least one year of trying.
Women who are able to get pregnant but then have repeat miscarriages
are also said to be infertile.

Pregnancy is the result of a
complex chain of events. In order to get pregnant:

A woman must release an egg from
one of her ovaries (ovulation).

The egg must go through a
fallopian tube toward the uterus (womb).

A man's sperm must join with
(fertilize) the egg along the way.

The fertilized egg must attach to
the inside of the uterus (implantation).

Infertility
can result from problems that interfere with any of these steps.

Is
Infertility a Common Problem?

About 12 percent
of women (7.3 million) in the United States aged 15-44 had
difficulty getting pregnant or carrying a baby to term in 2002,
according to the National Center for Health Statistics of the
Centers for Disease Control and Prevention.

Is Infertility
Just a Woman's Problem?

No, infertility is not always a
woman's problem. In only about one-third of cases is infertility due
to the woman (female factors). In another one third of cases,
infertility is due to the man (male factors). The remaining cases
are caused by a mixture of male and female factors or by unknown
factors.

Over the past twenty years, fertility problems have increased
dramatically. At least 25 percent of couples planning a baby will
have trouble conceiving, and more and more couples are turning to
fertility treatments to help them have a family.

What is the
cause? From a medical point of view, infertility is believed to be
caused by the following factors, and in these proportions.

Problem
Percentage of Causes

Ovulatory failure (including Polycystic Ovary
Syndrome)

20

Tubal damage

15

Endometriosis

5

Male problems

26

Unexplained

30

Causes of Infertility

In Male

A number of
causes exist for male infertility that may result in impaired sperm
count or mobility, or impaired ability to fertilize the egg. The
most common causes of male infertility include abnormal sperm
production or function, impaired delivery of sperm, conditions
related to a man's general health and lifestyle, and overexposure to
certain environmental elements:

Abnormal Sperm Production or Function.

Most cases of
male infertility are due to sperm abnormalities, such as:

Impaired shape and movement of sperm.
Sperm must be properly shaped and able to move rapidly and
accurately toward the egg for fertilization to occur. If the
shape and structure (morphology) of the sperm are abnormal or
the movement (motility) is impaired, sperm may not be able to
reach the egg.

Absent sperm production in testicles.
Complete failure of the testicles to produce sperm is rare,
affecting very few infertile men.

Low sperm concentration. A normal
sperm concentration is greater than or equal to 20 million sperm
per milliliter of semen. A count of 10 million or fewer sperm
per milliliter of semen indicates low sperm concentration (subfertility).
A count of 40 million sperm or higher per milliliter of semen
indicates increased fertility.

Varicocele. A varicocele is a
varicose vein in the scrotum that may prevent normal cooling of
the testicle and raise testicular temperature, preventing sperm
from surviving.

Undescended testicle (cryptorchidism).
This occurs when one or both testicles fail to descend from the
abdomen into the scrotum during fetal development. Undescended
testicles can cause mild to severely impaired sperm production.
Because the testicles are exposed to the higher internal body
temperature compared to the temperature in the scrotum, sperm
production may be affected.

Testosterone deficiency (male hypogonadism).
Infertility can result from disorders of the testicles
themselves, or an abnormality affecting the hypothalamus or
pituitary glands in the brain that produce the hormones that
control the testicles.

Klinefelter's syndrome. In this
disorder of the sex chromosomes, a man has two X chromosomes and
one Y chromosome instead of one X and one Y. This causes
abnormal development of the testicles, resulting in low or
absent sperm production. Testosterone production also may be
lower.

Infections.
Infection may temporarily affect sperm motility. Repeated bouts
of sexually transmitted diseases (STDs), such as chlamydia and
gonorrhea, are most often associated with male infertility.
These infections can cause scarring and block sperm passage.
Mycoplasma is an organism that may fasten itself to sperm cells,
making them less motile. If mumps, a viral infection usually
affecting young children, occurs after puberty, inflammation of
the testicles can impair sperm production. Inflammation of the
prostate (prostatitis), urethra or epididymis also may alter
sperm motility.

In many
instances, no cause for reduced sperm production is found. When
sperm concentration is less than 5 million per milliliter of semen,
genetic causes could be involved. A blood test can reveal whether
there are subtle changes in the Y chromosome.

Impaired Delivery of Sperm

Problems with
the delivery of sperm from the penis into the vagina can cause
infertility. These may include:

Sexual issues. Often treatable,
problems with sexual intercourse or technique may affect
fertility. Difficulties with erection of the penis (erectile
dysfunction), premature ejaculation, painful intercourse (dyspareunia),
or psychological or relationship problems can contribute to
infertility. Use of lubricants such as oils or petroleum jelly
can be toxic to sperm and impair fertility.

Retrograde ejaculation. This
occurs when semen enters the bladder during orgasm rather than
emerging out through the penis. Various conditions can cause
retrograde ejaculation including diabetes, bladder, prostate or
urethral surgery, and the use of psychiatric or antihypertensive
drugs.

Blockage of epididymis or ejaculatory ducts.
Some men are born with blockage of the part of the testicle that
contains sperm (epididymis) or ejaculatory ducts. And some men
who seek treatment for infertility lack the tubes that carry
sperm (vasa deferentia).

No semen (ejaculate). The absence
of ejaculate may occur in men with spinal cord injuries or
diseases. This fluid transports sperm through the penis into the
vagina.

Misplaced urinary opening (hypospadias).
A birth defect can cause the urinary (urethral) opening to be
abnormally located on the underside of the penis. If not
surgically corrected, this condition can prevent sperm from
reaching the cervix.

Anti-sperm antibodies. Antibodies
that target sperm and weaken or disable them usually occur after
surgical blockage of part of the vas deferens for male
sterilization (vasectomy). Presence of these antibodies may
complicate the reversal of a vasectomy.

Cystic fibrosis.
Men with cystic fibrosis often have missing or obstructed vasa
deferentia.

SPERM

Average
body's production

50,000
per minute/72 million per day (and remember lads, it only
takes 1)

Days to
maturity

84

Number
in ejaculate of average fertile man

200 to
600 million

Number
of ejaculate of infertile man

less
than 50 million

Percentage of total ejaculate

3% - 5%

Average
swimming speed

1 to 4
millimeters per minute

Average
life span once mature

1 month
in you, 1 to 2 days in woman, 2 minutes on sheets

General
Health and Lifestyle

A man's general
health and lifestyle may affect fertility. Some common causes of
infertility related to health and lifestyle include:

Emotional stress. Stress may
interfere with certain hormones needed to produce sperm. Your
sperm count may be affected if you experience excessive or
prolonged emotional stress. A problem with fertility itself can
sometimes become long term and discouraging, producing more
stress. Infertility can affect social relationships and sexual
functioning.

Malnutrition. Deficiencies in
nutrients such as vitamin C, selenium, zinc and folate may
contribute to infertility.

Obesity. Increased body mass may
be associated with fertility problems in men.

Cancer and its treatment. Both
radiation and chemotherapy treatment for cancer can impair sperm
production, sometimes severely. The closer radiation treatment
is to the testicles, the higher the risk of infertility. Removal
of one or both testicles due to cancer also may affect male
fertility. You may want to consider freezing (cryopreserving)
your sperm before cancer treatment to ensure future fertility.

Alcohol and drugs. Alcohol or
drug dependency can be associated with general ill health and
reduced fertility. The use of certain drugs also can contribute
to infertility. Anabolic steroids, for example, which are taken
to stimulate muscle strength and growth, can cause the testicles
to shrink and sperm production to decrease.

Other medical conditions. A
severe injury or major surgery can affect male fertility.
Certain diseases or conditions, such as diabetes, thyroid
disease, HIV/AIDS, Cushing's syndrome, anemia, heart attack, and
liver or kidney failure, may be associated with infertility.

Age. A gradual decline in
fertility is common in men older than 35.

Environmental Exposure

Overexposure to
certain environmental elements such as heat, toxins and chemicals
can reduce sperm count either directly by affecting testicular
function or indirectly by altering the male hormonal system.
Specific causes include:

Pesticides and other chemicals.
Herbicides and insecticides may cause female hormone-like
effects in the male body and may be associated with reduced
sperm production. Exposure to such chemicals also may contribute
to testicular cancer. Men exposed to hydrocarbons, such as
ethylbenzene, benzene, toluene, xylen and aromatic solvents used
in paint, varnishes, glues, metal degreasers and other products,
may be at risk of infertility. Men with high exposure to lead
also may be more at risk.

Testicular exposure to overheating.
Frequent use of saunas or hot tubs can elevate your core body
temperature. This may impair your sperm production and lower
your sperm count.

Substance abuse. Cocaine or heavy
marijuana use may temporarily reduce the number and quality of
your sperm.

Tobacco smoking. Men who smoke
may have a lower sperm count than do those who don't smoke.

This condition
usually results from inflammation of the fallopian tube (salpingitis).
Chlamydia is the most frequent cause. Tubal inflammation may go
unnoticed or cause pain and fever.

Tubal damage with
scarring is the major risk factor of a pregnancy in which the
fertilized egg is unable to make its way through the fallopian tube
to implant in the uterus (ectopic pregnancy). One episode of tubal
infection may cause fertility difficulties. The risk of ectopic
pregnancy increases with each occurrence of tubal infection.

Endometriosis

Endometriosis
occurs when the tissue that makes up the lining of the uterus grows
outside of the uterus. This tissue most commonly is implanted on the
ovaries or the lining of the abdomen near the uterus, fallopian
tubes and ovaries. These implants respond to the hormonal cycle and
grow, shed and bleed in sync with the lining of the uterus each
month, which can lead to scarring and inflammation. Pelvic pain and
infertility are common in women with endometriosis.

Infertility in
endometriosis also may be due to:

Ovarian cysts (endometriomas).
Ovarian cysts may indicate advanced endometriosis and often are
associated with reduced fertility. Endometriomas can be treated
with surgery.

Scar tissue. Endometriosis may
cause rigid webs of scar tissue between the uterus, ovaries and
fallopian tubes. This may prevent the transfer of the egg to the
fallopian tube.

Ovulation Disorders

Some cases of
female infertility are caused by ovulation disorders. Disruption in
the part of the brain that regulates ovulation
(hypothalamic-pituitary axis) can cause deficiencies in luteinizing
hormone (LH) and follicle-stimulating hormone (FSH). Even slight
irregularities in the hormone system can affect ovulation.

Specific causes of
hypothalamic-pituitary disorders include:

Direct injury
to the hypothalamus or pituitary gland

Pituitary
tumors

Excessive
exercise

Anorexia
nervosa

Elevated Prolactin
(Hyperprolactinemia)

The hormone
prolactin stimulates breast milk production. High levels in women
who aren't pregnant or nursing may affect ovulation. An elevation in
prolactin levels may also indicate the presence of a pituitary
tumor. In addition, some drugs can elevate levels of prolactin. Milk
flow not related to pregnancy or nursing (galactorrhea) can be a
sign of high prolactin.

Polycystic Ovary Syndrome (PCOS)

An increase in
androgen hormone production causes PCOS. In women with increased
body mass, elevated androgen production may come from stimulation by
higher levels of insulin. In lean women, the elevated levels of
androgen may be stimulated by a higher ratio of luteinizing hormone
(LH). Lack of menstruation (amenorrhea) or infrequent menses (oligomenorrhea)
are common symptoms in women with PCOS.

In PCOS, increased
androgen production prevents the follicles of the ovaries from
producing a mature egg. Small follicles that start to grow but can't
mature to ovulation remain within the ovary. A persistent lack of
ovulation may lead to mild enlargement of the ovaries.

Without ovulation,
the hormone progesterone isn't produced and estrogen levels remain
constant. Elevated levels of androgen may cause increased dark or
thick hair on the chin, upper lip or lower abdomen as well as acne
and oily skin.

Early Menopause (Premature Ovarian
Failure)

Early menopause is
the absence of menstruation and the early depletion of ovarian
follicles before age 35. Although the cause is often unknown,
certain conditions are associated with early menopause, including:

Autoimmune
disease. The body produces antibodies to attack its own tissue,
in this case the ovary. This may be associated with
hypothyroidism (too little thyroid hormone).

Radiation or
chemotherapy for the treatment of cancer.

Tobacco
smoking.

Benign Uterine Fibroids

Fibroids are benign
tumors in the wall of the uterus and are common in women in their
30s. Occasionally they may cause infertility by interfering with the
contour of the uterine cavity, blocking the fallopian tubes.

Pelvic Adhesions

Pelvic adhesions
are bands of scar tissue that bind organs after pelvic infection,
appendicitis, or abdominal or pelvic surgery. They may limit the
functioning of the ovaries and fallopian tubes and impair fertility.
Scar tissue formation inside the uterine cavity after a surgical
procedure may result in a closed uterus and ceased menstruation (Asherman's
syndrome). This is most common following surgery to control uterine
bleeding after giving birth.

Other Causes

A number of other
causes can lead to infertility in women:

Medications. Temporary
infertility may occur with the use of certain medications. In
most cases, fertility is restored when the medication is
stopped.

Thyroid problems. Disorders of
the thyroid gland, either too much thyroid hormone
(hyperthyroidism) or too little (hypothyroidism), can interrupt
the menstrual cycle and cause infertility.

Cancer and its treatment. Certain
cancers particularly female reproductive cancers — often
severely impair female fertility. Both radiation and
chemotherapy may affect a woman's ability to reproduce.
Chemotherapy may impair reproductive function and fertility more
severely in men than in women.

Risk Factors

Many of the risk factors for both male
and female infertility are the same. They include:

Age. Age is the strongest
predictor of female fertility. After about age 32, a woman's
fertility potential gradually declines. A woman does not renew
her oocytes (eggs). Infertility in older women may be due to a
higher risk of chromosomal abnormalities that occur in the eggs
as they age. Older women are also more likely to have health
problems that may interfere with fertility. The risk of
miscarriage also increases with a woman's age. A gradual decline
in fertility is possible in men older than 35.

Tobacco smoking. Women who smoke
tobacco may reduce their chances of becoming pregnant and the
possible benefit of fertility treatment. Miscarriages are more
frequent in women who smoke.

Alcohol. There's no certain level
of safe alcohol use during conception or pregnancy.

Body mass. Extremes in body mass
— either too high (body mass index, or BMI, of greater than
25.0) or too low (BMI of lower than 20.0) — may affect ovulation
and increase the risk of infertility.

Being overweight. Among American
women, infertility often is due to a sedentary lifestyle and
being overweight.

Being underweight. Women at risk
include those with eating disorders, such as anorexia nervosa or
bulimia, and women following a very low-calorie or restrictive
diet. Strict vegetarians also may experience infertility
problems due to a lack of important nutrients such as vitamin
B-12, zinc, iron and folic acid. Marathon runners, dancers and
others who exercise very intensely are more prone to menstrual
irregularities and infertility.

What's Normal?

Most pregnancies occur during the first six
cycles of intercourse in the fertile phase. Overall, after 12 months
of unprotected intercourse, approximately 85 percent of couples will
become pregnant. Over the next 36 months, about 50 percent of the
remaining couples will go on to conceive spontaneously.

Conditions Affecting Both Partners

A number of factors that affect males and females alike can
increase the risk of infertility. Perhaps the most common problem is
age the older a person is, the more difficult it is to become
pregnant. Over the last 20 to 30 years there has been a trend to
delay childbearing, often until women are in their 30s. A woman
reaches her peak fertility at age 18 or 19, with little change until
the mid-20s. As she approaches age 30, her hormone levels start to
decline and her fertility also begins a slow decline, with a more
rapid decline after age 35. Menopause, which occurs in the late 40s
to early 50s in most women, marks the end of a woman’s natural
ability to bear children. A man’s fertility decline is not as rapid
and has no clear-cut end point, but a man of 50 has lower hormone
levels and is likely less fertile than he was at age 25 or 30.

What Are Infertility, Sub fertility, and
Sterility?

Doctors use these and other terms to define
different types of fertility-related conditions. Even so, the
definitions of the above terms have changed as technology has
advanced.

Sterility
is the absolute inability to procreate. For instance, a woman has no
uterus or a man has no testes (the male sex organs). In years past,
a woman with blocked fallopian tubes or a man with an obstructed vas
deferens would be considered sterile and beyond help. With the
advent of assisted reproductive technology (ART), however, this is
no longer the case. Many couples who were once in this category can
now get help.

Infertility
is usually defined as the inability to achieve pregnancy after one
year of frequent, unprotected intercourse. This is not an exact
measurement. Over time many couples in this category may, in fact,
achieve pregnancy. Statisically, after five years, nearly one half
of so-called "infertile" couples do conceive.

Subfertility
is used to describe the gray area between normal fertility and
sterility; the term is often used interchangeably with infertility.

Fecundability,
from "fecunditas," the Latin word for fertility, is the average
pregnancy rate after one menstrual cycle. The normal rate in humans
is 20%. Seventy-five percent of normally fertile couples are
expected to have conceived in six months, and almost 100% by one
year.

Normal fertility can be considered from the
point of view of the couple, the female, or the male. We are going
to look at male fertility its biological steps and mechanisms,
defects, the causes of those defects and what can be done to remedy
them.

Normal Male Fertility

As male factors have been increasingly
implicated as a major cause of infertility, investigators have
focused on the underlying physical processes in men. If the sperm
count is low, then why? Or, if the sperm count is normal, why do the
sperm not fertilize?

That there are literally dozens of factors
leading to a completely normal spermatozoon, the form of sperm that
is present in semen. These involve the structure of the testis; the
hormones that influence its function; the receptors for these
hormones; the maturation process through which the germ cell
develops into a spermatozoon; the composition of the seminal plasma;
and all the enzymes, receptors, and reactions that make the sperm
capable of fertilizing the egg. In these steps, there are dozens of
occasions for mistakes and problems.

Normal Female
Fertility

Knowing your own body and being able to tell
when you are fertile or ovulating is an important skill that every
woman should have. You will save yourself an enormous amount of
worry and anxiety when you get to know your body and can control
your risk of unwanted pregnancy.

The fact is that there are only certain times
during your menstrual cycle when you are fertile or can get pregnant
in. So it pays off to know when those times are.

Your body will give you clear clues and
signals as to when fertility is approaching and happening.

A woman is fertile when she is ovulating and
for a few days before ovulation when fertile cervical mucus is
present.

Ovulation usually occurs mid cycle. More
precisely, ovulation usually occurs 14 days before the onset of
bleeding.

Not at day 14 of the menstrual cycle as is
commonly believed.

However - ovulation can be upset and delayed
by many factors, eg, sickness, alcohol, travel, stress etc which is
why simply counting the days can be inaccurate.

You will find your success in tracking your
fertility will be far greater when you become adept at recognizing
your own personal fertility signals rather than just counting the
days.

Ovulation can also spontaneously occur during
your natal lunar phase. Your natal lunar (moon) phase fertile time
can occur at any time during your menstrual cycle, including before,
during and after your period.

Your
natal lunar fertile time is individual to you and is calculated from
your birth data - it is all to do with which phase of the moon you
were born under.